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HomeMy WebLinkAbout2025-00049188 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets Mil l III H IIII IIIIII 0110010111111111111111 III DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003906561 u, 1 U21 1 1 2 u,16 U2 1 U, 1 u2 1 U, 1 U2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑S501-S1.500 ®ON SCENE 3 VEHICLE/PROPERTY [8]OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 2025I 2025-00049188 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 7 m ® ❑ RELATED ❑Y ®N 07 30 2025 IgIAM ❑YES ®NO U1 -< RT20 WB Elgin07:02 g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W ILLINOIS EXIT RAMP COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 7 Cl) ❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n T TOWED U1 FOR DAMAGEDAREA(S) FROM 0NAME(LAST,FIRST,M) p mo /1 9 8 8 Sterling LT7500 2003 00-NONE , • 2 , DUE TO CRASH ® ❑ 13-UNDER CARRIAGE ©, :: FIRE ❑ Cgl STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 1 M M I 2 4 ❑Y ®Nn is-OTHER SYSTEM ❑UNK VEH. AT CRASHD 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;ii_6 1,.4 COM VEH ® 0 2 C) " �- SOUTH ELGIN N I L 60177 0 1 0 FIRST CONTACT 12 7 • _-s *If Yes.See Sidebar U1 Z41248TV IL 2026 E TELEPHONE IL A 7 2FZHAZA853AK83872 Artisan&Truckers ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 99 9 Rock Ready Mix Compa 977047716 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 21 0 m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 KGV 0 Dv !1 9 8 7 Freightliner Cddplk 2025 00-NONE ,._"j t2..-_, DUETO CRASH ❑ ® 20 oy Yr 13-UNDER CARRIAGE 161 c. 2 FIRE ❑ ® U2 C Ti M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 g POINT OF s i C 4 COM VEH ® ❑ U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 00 Yd�_:6 •(ryes,See Sidebar C ZCRYSTAL LAKE IL 60014 0 1 0 P1289234 IL 2026 I 0 Si) D IL A 7 3AKJHTDV8SSWG4366 Diamond Bros Insurance ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 10 = 99 9 Sunset Cartage Inc EBA0550613 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y U2 Z N 1 El 11 1 Sunset Cartage Inc Trailer 07,30 ,2025 07 02 0 AM in a Work Zone? ❑N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) 2 ❑ 1320 S VI RG I N IA RD Crystal Like 60014 28 03 07,30 ,2025 07 03 ❑PM • ®Construction * R 3 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ®AM ❑Maintenance U2 -a, ARREST NAME Tecuanapa Cruz. Israel. D. 11-601 1543000218 07,30,2025 07 10 ❑pM SLMT 1 ER 1 ❑CITATIONS ISSUED ❑PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME • ❑ t 2 El ARREST NAME 07/30 ,2025 01 30 0 PM El Unknown work zone type U1 El AM 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ®Y 45 1543-Sturgeon. Kyle 400 07 ,30,2025 08 14 ❑PM 0 N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ` ` '' -' r INDICATE NORTH combination):or —I i nar?a?Atat?eeere 1aod ,evanie„drttw, BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C aP ne ' _ (example:shuttle or charter bus):or 0 < -----------; Van- -une - - } } transporting mploned to aeeslin the course of 5 or fewer passengers er employment(example:employee a contract rier transporter-usually a van type vehicle or passenger car): rco L L.___a____.l 1 - } } •4. Is used or designated to transport between 9 and 15passengers,induding the driver, C for direct compensation(example:large van used for specific purpose):or L L----a----. 9 ® - t l. I 1 L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 0 placarding(example:placards will be displayed on the vehicle). ® . 1 —\. . — CARRIER NAME Rock Ready Mix Company Z ADDRESS 24W733 LAKE ST 0 D A w N NOt TO Scale CITY/STATE/ZIP Elgin 1 I L/60172 MOTOR CARR.ID 0 Interstate El Intrastate 0 l I r l ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes ® No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ®No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ®No C Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes ®No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ti DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Arties/Unknown . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE